Patient Information & Forms

Insurance Information

Insurance coverage is verified prior to being seen. Co-pays, deductibles and non-covered services will be collected at the time of the visit. If you are not covered by one of our participating plans, as a courtesy, we will file your claim for you, but you will be ultimately responsible for any account balance.

We ask that you present your insurance card at each visit. It is your responsibility to provide us with the correct information to bill your insurance.

• If you have a change of address or telephone number(s), please notify our office immediately
• Your insurance is a contract between you, your employer, and the insurance company. We are not a party to that contract. It is very important that you understand the provisions of your policy. We cannot guarantee payment of all claims. If your insurance company pays only a portion of the bill or rejects your claim, any contact or explanation should be made to you, their policy holder.
• We will collect your deductible, co-payment, or charge for a non-covered services at the time of your visit. If you have a balance after an insurance payment from a previous service, we will also ask for that payment. We accept cash, checks, and major credit cards.
• If we do not participate with your insurance company, you will be expected to make payment in full at the time service is rendered.
• If your insurance denies our charges, or does not pay us in a timely manner, or if your account becomes delinquent we reserve the right to refer your account to a collection agency and to be reported to the credit bureau.
• No show or missed appointments – We understand there may be times when you are unable to keep an appointment, but we ask the courtesy of a phone call to cancel an appointment by you to avoid any cancellation fees.

Dermatology Surgery Center is a provider of most major insurance companies. Complete understanding of and cooperation with our practice financial policy is an essential element of your care and treatment. For those insurance plans in which we participate, your predetermined portion of charges set by your insurance plan (deductibles, co-pay and/or co-insurance) will be collected at the time of service. For your convenience we accept cash, check and major credit cards (Mastercard & VISA). If you wish to complete our credit card form it will be retained in a secure file and may be used to pay any balances older than 60 days. Should you have any questions or concerns, our billing department will be happy to assist you.

Please remember, whether you have insurance or not, you are ultimately financially responsible for payment of your charges. If you have any questions regarding our financial policy, please contact our office. Our friendly staff is ready to help and provide any information.